An estimated 64,000 people died from drug overdose in 2016 alone, and according to the Centers for Disease Control and Prevention (CDC), the majority of those deaths involved an opioid. In 2015, the U.S. Department of Health and Human Services estimated that more than 12.5 million people misused prescription opioids. That’s enough people to fill every professional football stadium in the U.S. to capacity--six times. While these statistics are staggering by themselves, they show just the tip of the iceberg when it comes to the enormity of the opioid crisis in the United States.

“We can be the generation that ends the opioid epidemic,” President Donald Trump said last month, as he declared the national opioid crisis a public health emergency.

Less than a week later, government, industry, and academia experts gathered in Washington D.C. for the 7th ICF/George Washington University (GW) Research and Evaluation Forum, Opioid Use: An Epidemic of Addiction, Not Abuse. The event featured a panel discussion on the underlying issues that complicate the U.S.’s ability to prevent and treat addiction.

During the first part of the event, J.D. Vance, best-selling author of Hillbilly Elegy: A Memoir of Family and Culture in Crisis, spoke with Frank Sesno, former CNN anchor and director of the GW School of Media and Public Affairs, about the economic and cultural factors that contribute to substance use disorders. Read on to learn more about some of the ingredients that Vance deems critical to resolving the crisis.

Focus on families first

Vance’s memoir tackles his own family’s dark and on-going struggle with opioids in rural Ohio, in a county where “deaths from drug overdoses actually outnumber deaths from natural causes.” He described how economic decline can create feelings of social dislocation, cultural disintegration, and depression—near-perfect conditions for addiction. Even worse, Vance explained, opioid addiction can proliferate very quickly—from non-user to non-functional addict in a matter of weeks—as compared with alcohol, which a person can abuse for years but remain functional. The drugs are readily available and lethally potent.

“People turn to substance abuse because the outlook for their communities seems hopeless…not just for today, but hopeless for the future as well,” he said.

For those communities, Vance feels it’s important to focus on helping one person at a time, and one family at a time. Elderly poverty is one serious ripple effect of the epidemic, not because older people are becoming addicted at a faster rate, but because many grandparents and extended family members become responsible, by default, for the abandoned children of addicts. Vance’s own grandparents became his safety net, but other extended family members can also serve in that role for children affected by opioids today. Displaced children who live with family members tend to have much better outcomes—almost on par with those who weren’t displaced at all—than those who end up in the foster care system.

Author @JDVance1 credits grandparents with rescuing him during mom’s SUD, fears for kids without family members able to step in. #ICFGWForum

But finding resources for these displaced families is just one piece of a bigger puzzle. Preventing problematic behavior among younger generations is another underlying complexity. Children who don’t have that next layer of family to catch them may experience more difficulties. “We haven’t cracked the code,” said Vance. “We haven’t figured out how to give stability to kids who can’t get it from their nuclear family.”

Ask what’s really going on in the lives of those we’re trying to help

Changing the conversation and reshaping policy surrounding opioid addiction is key to countering the epidemic. While “dignified work” is the pathway out of addiction for many, every dollar could actually prove counterproductive. Vance mentioned that his mother, who has now been clean for over two years, holds a steady job at a cleaning service but is concerned about what will happen if her salary increases. If she crosses over the poverty threshold, she could lose essential Medicaid coverage.

Vance challenged the audience to consider the dozens of issues that can affect people with opioid addictions--and how these issues are further exacerbated by the opioid epidemic--citing workforce participation, the U.S. education system, and social issues. He also asked the audience, particularly those who haven’t seen the effects of addiction, to consider the delicate balance between compassion and personal limits. Even those who dedicate their lives to resolving the crisis—through policy, advocacy, or within their own families—experience feelings of intense frustration and burnout.

“The most important lesson is to recognize that helping isn’t always easy--even for people who want to help, and who are compassionate,” said Vance. “And that is because these problems are difficult and complex.”

How can we take a holistic approach in addressing the many policy, social, and cultural aspects of the opioid epidemic? Share your thoughts with us on Twitter, LinkedIn, and Facebook using #ICFGWForum.